Tuesday, January 26, 2010

PUPPPS awareness.

So I figure that not enough people in the world know and understand what it is that PUPPPS really entails for a pregnant woman. What is it you ask? I am going to do a copy and paste of the most commonly known information about it:

Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is the most common rash in pregnant women. It normally occurs in first pregnancies during the third trimester with an average onset of 35 weeks. Thankfully, PUPPP does not usually affect subsequent pregnancies.

Appearance of PUPPP
The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button distinguishing it from other common rashes of pregnancy. The rash itself consists of small, red wheals in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles. Over the next several days, the rash can spread over the thighs, buttocks, breasts, and arms.

The rash is very itchy, or pruritic, hence the name. This condition is harmless to mother and baby, but can be very annoying. It lasts an average of 6 weeks and resolves spontaneously 1 to 2 weeks after delivery. The most severe itching normally lasts for no more than 1 week.

Cause of PUPPP
The cause of PUPPP is unknown. It is not associated with preeclampsia, autoimmune disorders, hormonal abnormalities, or fetal abnormalities. Some investigators suggest that the rapid abdominal wall distension damages connective tissue and causes an inflammatory response. One study has shown that male fetal DNA can be found in skin biopsies of the rash. Since 70% of women with PUPPP give birth to boys, a new hypothesis is that male fetal DNA acts as a skin irritant.

Diagnosis of PUPPP
The diagnosis of PUPPP is clinical, meaning it is based solely on the appearance of the rash. There are no laboratory tests that detect PUPPP. Skin biopsies are not generally performed unless there is a question about the diagnosis.

Treatment of PUPPP
The treatment of PUPPP is symptomatic. High strength steroid creams or ointments, such as clobetasol (Temovate) or betamethasone (Diplrolene), used up to 5 to 6 times a day usually relieve the itching and prevent the spread of the rash. Once the rash is under control, changing to a lower strength steroid used less frequently is advisable. For severe cases, daily oral steroids may be necessary to control itching. Oral antihistamines such as atarax, benadryl, and zyrtec, are generally less effective for itching than steroids, but may be useful at night to help with sleep.



How did PUPPPs affect me, do you ask? Well it sucked. It has been taking this pregnancy and filled it with a lot of miserable itching, ice packs, prescriptions, scabs, and general discomfort, modesty... The list goes on. I am almost certain I will have scars on my arms and legs from the scabs left behind from this. Hot showers didn't help me, oatmeal didn't help, aloe, diaper ointment... anything that you can slather on your skin.... Olive oil, shea butter, cocoa butter... Nothing. Even the steroid creams didn't 'help'. Now, I have general control over the problem because I have been told to take 4 steroid pills a day, 5 antihistamines a day, 2 different creams, and even have a sleeping pill for when it gets super bad. I got about a week and a half of the welts being under control before they started forming on my upper belly again. I currently still have them, but since I have my medication, it hasn't gotten as bad as it was. I have some pictures that I artfully (not) took myself to help you see what it is I have, in case you may have it too. Please disregard my poor job. :)
Under my arms...
and my belly of course. I was unable to take pictures of my own back... but I had plenty of welts there as well. Really, my body was covered. Even on my bum! Terrible. In the information I posted, it says it can be 'annoying'. But this is really the understatement of the year. Most women who have it this bad will explain how it is the worst thing they have ever experienced, as one feels a huge sense of helplessness. I felt as though I was slowly losing my mind, the constant itching and nothing being able to scratch, my skin felt and looked disgusting, covered in red welts all over. I was embarrassed to go outside. And still mostly am. Most people do not understand this condition, as it only affect 1% of pregnant women. So being pregnant, and covered in huge red welts everywhere, constantly itching everywhere, or as I am now, covered in disgusting scabs, and still itching everywhere, people just don't know why it is. And the many nights of sleep I lost because I was up crying helplessly, not understanding why I couldn't be like all the other pregnant women who didn't suffer from this, and how was I to deal with this for so long... my poor husband was so amazing, and did everything he could to ease my suffering. He brought me fresh ice packs... rubbed oil on my skin when the itching got so bad that I was practically convulsing, and his awesome support really helped me so much.

Please ladies, if you are suffering from itching in the palms of your hands or the soles of your feet, and do not have a rash, go to the doctor immediately! There could be a problem with your liver! They can determine this with blood tests. The doctors checked my blood as well, to rule out that problem for me. And if you are suffering from this terrible rash, I understand. I hate reading the line 'it is harmless to the mother' as it does hurt, physically and mentally and emotionally. If you need support, or have any questions, please feel free to ask me.

22 comments:

Trixi said...

Thanks for sharing this. Least I know I am not the only one.
I think you have your baby now. I hope the itching is gone.

Lindsey said...

Thanks for posting this. I think I have puppps and I didn't get it until 5 days after delivery. I delivered really early at 25.5 weeks and to a little boy. How weird about the male DNA stuff. Gotta get into the dermatologist tomorrow.

mare said...

im so sorry. i know what you went thru. no one should go thru it. i still have scars all over my body. horrible..

Anonymous said...

Thank you for saying it's not just irritating...it's doing my head in...which overdue pregnant women don't need to start with!!!

Steph said...

I have been suffering for 14 days and if another midwife or doctor says that it is not life threatening i think I will scratch their eyes out. I'm so glad my organised husband encouraged me to get things ready early because all I can do now is cry and cry and cry. I look just like the above photographs.I have tried every cream available nothing helps. I'm not keen to take tables. How the hell am I going to cope with labour, I have not slept well in 14 days. Thank goodness for my husband, brothers and friends who have supported me. I Wish anyone who is going through this good luck and happy babies.

Anonymous said...

I had this back in 2005 and was just showing some friends my symptoms and found your site. I was chronic like this from about 5 months onwards, I was going insane, living in cold climate having freezing showers. I was induced at 39 weeks 5 times and failed to go into labour and ended up with c section after my due date. I tried absolutely everything and 5 years later I have massive scarring from it - particularly over my stomach I am trying to get rid of and considering surgery.

Anonymous said...

hi there..i think i have i,its started when im 20weeks pregnant,i notice some bumps on my left thigh and my belly.i thought its just a mosquito bite but when i scratch it,it multiplies..i'm 24weeks now..my OB gave me a corticosteroid cream but it didn't work,then after a week i came back to her to ask why it multiplies,it also spread at my back,my boobs and my butt.then she gave me some oral corticosteroid for 7 days and it didn't work also..i make some research about what was happening so i found out that maybe it is PUPPP..its so itchy and i can't go to sleep at night..i just put some vaseline lotion with aloe vera to ease the itch..my legs is mostly like yours but not that worse..on aug 28 i'm going to visit my OB again and ask her what is this..your blog is very helpful..thanks for posting.

Meagan said...

I am no 11 days overdue, I was diagnosed with PUPPP at 41 weeks. I had itchy stretchmarks for a few weeks, they were lumpy and weeping almost. I scratched them too much - but try telling someone not to scratch ITS ITCHY!! Then at 40+5 I thought i had a few mosquito bites behind my right knee, then the next day I had a whole heap of red dots up my thigh. I spoke to the midwife who told me to go to the GP, who was USELESS and told me not to worry. The next morning they had at least quadrupled on my legs, I looked like I had been attacked by sandflies, and my stomach was all red & angry. The midwife told me to go and see the obstetrician at the hospital. After they tried 3 times to take blood, they did some tests and came back that it must be PUPPP. They gave me a low strength steroid cream, but that only worked on my stomach, the stretchmarks calmed way down and were no longer itchy, but the rash spread 10fold all over my legs, arms, backs of my hands, boobs and spread from my stomach to my sides and my bum. Luckily, my neck, face & back have been missed. I found the only thing helpful is cold compresses. I take an anti-histimine every 6 hours, and have been using sorbolene moisturiser after a shower. basically, my system is that if i feel really itchy, I get a cold pack and put it on where the itch is and it takes it away and gives me something else to think about. When I go to sleep, I try to wear clothing that is not irritating, and try not to overheat, I found that even though its cold, its worse to have a quilt over you, a top sheet doubled over is much better. I think above everything else, you really have to calm down, I know its hell, but you have to bring your psyche back to the fact that a. its temporary b. the baby is healthy and c. you're going to have a beautiful baby and this will all be over. Its a small price to pay for the end result. I"m still going through it, but I"m trying to stay positive. I may need to be induced tomorrow as i will be 41+5 but i'm giving myself 1 more day.

I have also read that dandelion root tablets are helpful as well as omega 3 however upon reading, I found that some people said that the dandelion root cleanses the toxins, but they then may pass through the baby. Best to check with your midwife or doc before using. The rash gets worse if you stress, so just calm down - I know its hard, but maybe get some accupuncture to help and keep busy!

good luck to anyone with this, I hope they put some money into more research. I am seriously thinking about starting a charity to raise funds. Don't know where to start though.

Amber and Brian said...

How do you look now? Are you completely scared from it?

I have PUPPPS. I am 32 weeks and have had it since 29 weeks. It's mostly on my belly, but I am starting to feel/see it on my arms and legs. It's AWFUL! Doctor prescribed the steriod cream which only helps for a few minutes. I find what helps the most is Grandpa's Pine Tar Soap (you can find it at Whole Foods/Sprouts, etc). I wash the infected area(s)a few times a day, as this stops the itching for a few hours rather than a few minutes at at time.

Anonymous said...

My symptoms started as soon as i found out i was pregnant, my pregnancy was a total suprise only because i was on the ortho evra patch for about two years & it worked fine until the day that i found out i was expecting. I am very excited about this baby,i would probably have never known about Puppp if i hadn't experienced it. I have never been so miserable, i've been to the e.r. Twice, & didn't get diagnosed till the second visit, i litterally had to break down crying at the e.r. Cause they were just about to give up on me, then they probably felt bad after i walked out crying, then they convinced me to go back to my hospital bed & a few minutes later the RN came back & said you have Puppp! I wasn't to convinced that i had it, cause the paperwork they gave me said it usually happens in the third trimester, but as i did my own research & read all the stories about puppp and how some people can get it this early, i'm convinced. I am about 11 weeks maybe i aint too sure how far along i am cause like i said i was on the patch & i am not too accurate about my last menstrual, i am gonna have an US next week to be more accurate, but first my ob doc sent me to the lab just to make sure that it is Puppp and nothing more serious (which i know it's not) but i understand. I have had this for about 4 weeks now the doc said it looks like Puppp but it is rare so early in pregnancy, but he also said it's possible. I am laying in bed right now so tempted to take an Atarax so i can sleep cause this itchiness is still so intense, but i'm the kind of person who hates taking pills especially being pregnant. I noticed that when i take a shower it makes it worse, my skin looks so terrible every time i look at my stomach, arms, thighs i start to cry cause i feel like it's never going away! I pray that i don't have scars. I also pray that i don't have this for the rest of my pregnancy :( i still have a long ways to go. Good luck to all you new mothers, & expecting mothers who are going through this, i hope you find relief, cause i still have'nt.

Anonymous said...

God I lay awake at night looking up blogs like this. thanks for sharing, it makes me feel better to do im not the only one who feels they are going insane. im 39 weeks, i started at 36, it horrible and its also spread all over me. the medicated creams didn't work. I scratch my legs like crazy, im afraid of scaring too. only thing that gives SOME relief is baby oil all over and then baby powder on top. aveeno cream i keep beside me in bed at night if i wake up itchy. this sucks

Anonymous said...

I had puppp from 16 weeks of pregnancy. It was absolutely awful. It too started like mosquito bites on my arm and then spread to my entire body. I tried all different types of creams, dandelion tea and flaxseed oil and nothing worked. My dermatologist told me using pinetarsol would aggrevate it more. I went to the hospital at 26 weeks because I couldnt sleep and was feeling exhausted and miserable. The hospital gave me an ointment called Betnovate ointment (strength 1mg/g) and by 32 weeks the puppp was completely gone. It was the best thing I tried. I had a beautiful little girl who is now 6 months but unfortunately the rash is starting to come back on my upper arms and thighs. I have no idea why because im not pregnant. Has anyone else had this happen to them???

leecha said...

hi im 20weeks pregnant and have had the rashes for about 3-4weeks now. my ob referred me to a dermatologist and the derma first diagnosed the rashes as mite bites and gave me lotions (Bethasone and Eurax lotion) it did help a little but as the weeks passed and the rashes spread, the itchiness becomes unbearable and im becoming so desperate. i put icepacks all over (belly, hip area, pubic area, breast and legs) use aveeno oatmeal bath and oil and continue to use the lotions doc gave me. i have yet to go back and show her the rashes had spread so meanwhile, im trying to research on my own and im quite convinced i have PUPPS. i dont know if i can still take it as i still have a long way to go. would appreciate more suggestions for relief. thanks much for this blog. goodluck to all moms esp experiencing this kind of problem.

Anonymous said...

I had the PUPPP on my 37th week. I was very cautious of stretch marks during my pregnancy that I lathered oil and moisturizer on my tummy only to be plastered with dark ugly rashes and welts because of the PUPPP. People who told me to stop scratching just didnt know how unbearable it is not to scratch when the itching starts. I was induced at 39th week because I had the rashes on my arms, legs, tummy and I started to lose sleep because of the itching. I also tried different home remedies and zyrtec, benadryl , hydrocortisone and triamcinolone cream but to no avail. Im scared to take any strong steroid-based medications for fear it might pass to my baby as I am breastfeeding. Its been almost 4 weeks now and the itching still persists . I start to have the itching and rashes on my neck, back, chest, groin area and my hands and feet including the soles and the palms. I thought that the itching and the rashes are gonna go away after I had the baby but i feel like it is not gonna stop until my whole body is covered by rashes and welts. I think I need to see another dermatologist because I dont think Im getting any better.

Anonymous said...

It's somehow a relief to know you are not alone with this. I've tried lots of the ideas suggested. My ''best" combination has been calamine lotion and piriton. Occasionally I've replaced the piriton with a paracetamol (as this seems to be more readily "safe" during pregnancy) and I have to say it seemed to have roughly the same effect of taking the edge off the itching. I've also upped to 2 or 3 showers a day including exfoliation. I'm 2 weeks in on the itching and my stomach stretch marks (where it started) have significantly calmed down, while all the areas it had spread to flared up section by section... I'm hoping it's a cycle and I can get the rest to calm down with the same approach.

Anonymous said...

My wife having gone through 3 natural births was forced into an emergency C-section on our 4th child. Shortly after the C-section she developed a nasty rash. Very similar to heat rash, all over he mid section. We were told there was nothing that could be done about it.. She was prescribed an antihistamine and sent home. Follow the birth of our 5th child( also a C section) she developed the same rash. Again we were told there was nothing that could be done about it.. It was hormonal, or it was just a reaction to the betedine. Considering my wife tested negative for betadine allergy, I was not convinced. On the birth of our 6th child I requested a treatment plan. Low dose steroids and Claritin were administered prior to C section. Also, the area was prepped with Chlorhexidine rather than betadine. And last but most importantly, I requested that the doctor allow the placenta to detach naturally rather than surgically.

All of the requests were followed and my wife has had no reaction to her C section. NO RASH... I am so happy for her.. Just my 2 cents.


Pups Prevention Protocol
Low Dose Steroids (Prior to procedure)
Claritin (Prior to procedure)
Chlorhexidine prep
Natural placental detachment

Anonymous said...

Ok, I had it just as bad, 7 months later I have hideous scars all over especially on my legs. How do I get rid of them?

Anonymous said...

I had a emergency c-section at 37.5 weeks to a baby boy and had severe itching from the epidural. About 6 weeks after having baby I developed a rash on my stomach, but mostly my thighs. It is now 7 months later and I still have it. I don't know what to do.

Anonymous said...

I had it too, was so desperate looking for ways to relieve the itch.. Tried everything but non works, cried everyday. I was so glad the day came with baby in my arms, INSTANT relieve!
To all mum and mum to be, hang on! I know it's almost impossible but pls try! God bless..

Sheena Mahlberg said...

I had a rash start when I was around 20 weeks. It started under my breast. At first thought it was poison ivy. I couldn't see it very well. Then when it wouldn't go away and got much worse. After a round of oral steroids. It cleared up for about two weeks. It started to come back and again was everywhere even worse this time. I wouldn't wish this rash on anyone. About a week before I had my girl my doctor had me start another oral steroid. I was induced at 38 weeks. My OBYN told me the rash should clear up in about two weeks. I still had some of the steroids left I asked her if she wanted me to keep taking it she said yes. Well two weeks later I still had a rash. I didn't want anymore steroids. So I just waited for the rash to go away. It started to fad away slowly I had the rash untell my daughter was 3 months old. I still get small rashes to this day. Right now I have a rash on my left arm. My daughter is about to be 6 months old. At the worst of it I had it from the top of my neck all the way down to the top of my feet. I didn't sleep but a hour a night. I had never even heard about PUPPPS before this. I also hated to go outside I did like the fact it was winter so I wore long sleeve everywhere but you could still see the rash on my neck and top of my hands. I can just hope that one day I will never have to deal with this rash again.

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Anonymous said...

Hi there, I have rash on my thighs even before I found out that I am pregnant. I am now ~6 weeks and the PUPPPS has covered the front of my both thighs. Thank you for showing your PUPPPS, mine looks exactly the same on the thighs

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